London's Pulse: Medical Officer of Health reports 1848-1972
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Hints from the Health Department. Leaflet from the archive of the Society of Medical Officers of Health. Credit: Wellcome Collection, London
London County Council 1928
[Report of the Medical Officer of Health for London County Council]
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in their general health. It is believed that many of these children would benefit and
respond well to the regime of an ordinary open-air school.
"Since the matter of moment in rheumatic children is the condition of the heart, it is of interest to note this feature in the children seen:—
| Elizabeth Bullock Centre— | Nil. | Congenital. | Suspicious. | Definite. |
|---|---|---|---|---|
| Girls | 36 | 3 | 33 | 22 |
| Boys | 28 | 2 | 30 | 10 |
| Totals | 64 | 5 | 63 | 32 |
| Downham Centre— | ||||
| Girls | 38 | 4 | 35 | 10 |
| Boys | 22 | 1 | 23 | 9 |
| Totals | 60 | 5 | 58 | 19 |
"The relatively small numbers of children with definitely affected hearts is due
to a very extensive and efficient supervision now carried out at the hospitals and in
P.D. schools. If prevention is to be useful attention must be focussed on the
children without cardiac involvement and those with suspicious hearts, although
every child with active rheumatism must be treated.
"The disposal and regulation of all these children form a considerable part of
the work at the centres. To exclude from school without just cause is almost as
harmful as to allow a child with active carditis to attend school and participate in
competitive games. In many cases the lot even of a delicate child is more propitious
when attending school in a relatively warm, open and happy environment, watched
over by an observant and kindly disposed teacher, fortified by school meals if necessary,
and stimulated by the wide variety of school interests, than sitting or working
in what is often a stuffy and ill-regulated home or roving the inclement streets.
Physical exercises can be better limited to the needs of the child in school than out
of it; nor need the over-anxious child be pressed in his school work if the doctor
thinks it would be injudicious. Teachers heartily co-operate in dealing with delicate
children. School exercises are forbidden to children whose heart muscles or valves
are not functioning properly, but where there is active carditis, bed alone is the
place, and this can, in the majority of cases, only be secured in hospital.
"The following table shows the lines upon which the children were treated. The numbers total more than the actual children seen, as some of them appear in two columns, e.g., excluded school while waiting institutional treatment.
| Centre. | School and no restrictions. | School and restrictions. | Treatment while attending school. | Treatment and excluded from school. | Institutional treatment. | Convalescence. | P.D. |
|---|---|---|---|---|---|---|---|
| Elizabeth Bullock | 47 | 45 | 10 | 31 | 26 | 30 | 8 |
| Downham | 57 | 32 | 13 | 20 | 14 | 19 | 5 |
"While restriction in school games and exercises must depend on the condition
of the individual child—experience shows that swimming, unless under the strictest
supervision, is detrimental to definitely rheumatic children—acute exacerbations of
rheumatism have followed in some cases where rheumatic children have gone to the
swimming baths contrary to instructions. All the children under treatment were
attending hospitals or private practitioners.
"39 children were discharged after their first re-examination at the Elizabeth
Bullock Centre, and 36 at Downham—with the proviso that they were to re-attend
on the recurrence of any symptoms. The remaining 112 children at the Elizabeth
Bullock Centre and 87 at Downham were referred for re-examination at periods